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Wang K, Liu X, Ding Y, Sun S, Li J, Geng H, Xu M, Wang M, Li X, Sun D. A pretreatment prediction model of grade 3 tumors classed by the IASLC grading system in lung adenocarcinoma. BMC Pulm Med 2023; 23:377. [PMID: 37805451 PMCID: PMC10559613 DOI: 10.1186/s12890-023-02690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 09/28/2023] [Indexed: 10/09/2023] Open
Abstract
PURPOSE The new grading system for invasive nonmucinous lung adenocarcinoma (LUAD) in the 2021 World Health Organization Classification of Thoracic Tumors was based on a combination of histologically predominant subtypes and high-grade components. In this study, a model for the pretreatment prediction of grade 3 tumors was established according to new grading standards. METHODS We retrospectively collected 399 cases of clinical stage I (cStage-I) LUAD surgically treated in Tianjin Chest Hospital from 2015 to 2018 as the training cohort. Besides, the validation cohort consists of 216 patients who were collected from 2019 to 2020. These patients were also diagnosed with clinical cStage-I LUAD and underwent surgical treatment at Tianjin Chest Hospital. Univariable and multivariable logistic regression analyses were used to select independent risk factors for grade 3 adenocarcinomas in the training cohort. The nomogram prediction model of grade 3 tumors was established by R software. RESULTS In the training cohort, there were 155 grade 3 tumors (38.85%), the recurrence-free survival of which in the lobectomy subgroup was better than that in the sublobectomy subgroup (P = 0.034). After univariable and multivariable analysis, four predictors including consolidation-to-tumor ratio, CEA level, lobulation, and smoking history were incorporated into the model. A nomogram was established and internally validated by bootstrapping. The Hosmer-Lemeshow test result was χ2 = 7.052 (P = 0.531). The C-index and area under the receiver operating characteristic curve were 0.708 (95% CI: 0.6563-0.7586) for the training cohort and 0.713 (95% CI: 0.6426-0.7839) for the external validation cohort. CONCLUSIONS The nomogram prediction model of grade 3 LUAD was well fitted and can be used to assist in surgical or adjuvant treatment decision-making.
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Affiliation(s)
- Kai Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Xin Liu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Yun Ding
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Shuai Sun
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Jiuzhen Li
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Hua Geng
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Pathology, Tianjin Chest Hospital of Tianjin University, Tianjin, China
| | - Meilin Xu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Pathology, Tianjin Chest Hospital of Tianjin University, Tianjin, China
| | - Meng Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Xin Li
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China
| | - Daqiang Sun
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- Department of Thoracic Surgery, Tianjin Chest Hospital, Jinnan District, No. 261, Taierzhuang South Road, Tianjin, 300222, China.
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Prognostic histologic subtyping of dominant tumor in resected synchronous multiple adenocarcinomas of lung. Sci Rep 2021; 11:9539. [PMID: 33953254 PMCID: PMC8100294 DOI: 10.1038/s41598-021-88193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
The prognostic role of histological patterns of dominant tumor (DT) and second dominant tumor (sDT) in synchronous multiple adenocarcinoma (SMADC) of lung remains unclear. SMADC patients diagnosed between 2003 and 2015 were retrospectively reviewed. DT and sDT were defined as two maximum diameters of consolidation among multiple tumors. Histological pattern was determined using IASLC/ATS/ERS classification system. DTs were divided into low- (lepidic), intermediate- (acinar, papillary) and high-grade (micropapillary, solid) subtypes, and sDTs into non-invasive predominant (lepidic) and invasive predominant (acinar, papillary, micropapillary, solid) subtypes. During mean 74-month follow-up among 149 nodal-negative patients having SMADC resected, recurrence was noted in 44 (29.5%), with significantly higher percentage in high-grade DT (p < 0.001). Five-year overall (OS) and disease-free (DFS) survivals in low-, intermediate- and high-grade DT were 96.9%, 94.3%, 63.3% (p < 0.001) and 100%, 87.2%, 30.0%, respectively (p < 0.001). Cox-regression multivariate analysis demonstrated high-grade DT as a significant predictor for DFS (Hazard ratio [HR] 5.324; 95% CI 2.570–11.462, p < 0.001) and OS (HR 3.287; 95% CI 1.323–8.168, p = 0.010). Analyzing DT and sDT together, we found no significant differences in DFS, either in intermediate- or high-grade DT plus invasive or non-invasive sDT. DT was histologically an independent risk factor of DFS and OS in completely resected nodal-negative SMADCs.
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Tang J, Curull V, Ramis-Cabrer D, Duran X, Rodríguez-Fuster A, Aguiló R, Barreiro E. Preoperative Body Weight and Albumin Predict Survival in Patients With Resectable Lung Neoplasms: Role of COPD. Arch Bronconeumol 2020; 57:51-60. [PMID: 32877328 DOI: 10.1016/j.arbres.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The impact of preoperative nutritional status on survival in lung cancer (LC) patients with underlying chronic obstructive pulmonary disease (COPD) is still unclear. We hypothesized that presurgical nutritional assessment may differentially predict mortality in patients with resectable LC with moderate COPD and relatively well-preserved nutritional status. METHODS Nutritional assessment [body mass index (BMI), blood parameters including albumin and protein levels, and body weight loss], and other clinical parameters [cigarette smoking (CS) history, LC staging and histological subtypes, COPD severity, lung function, and adjuvant therapy] were evaluated in 125 patients from the LC Mar Prospective Cohort: 87 LC-COPD patients and 38 LC patients without COPD before thoracotomy. Ten-year overall survival (OS) was analyzed in all patients. RESULTS Prior to thoracotomy, in LC-COPD patients compared to LC, BMI and albumin declined relatively, low levels of the parameters BMI, albumin, and total proteins were associated with poorer 10-year survival, especially in the LC-COPD. CS burden also correlated with impaired survival. COPD per se worsened the prognosis in LC patients. CONCLUSIONS In the present cohort of LC patients with resectable tumors and relatively well-preserved nutritional status, the parameters BMI and blood albumin and protein levels measured prior to thoracotomy predicted OS, especially in those with COPD. These are clinically relevant findings, since values of those nutritional parameters were within the normal ranges in the majority of the analyzed patients. A thorough nutritional preoperative assessment should be included in the study of patients with resectable LC, particularly in those with chronic airway obstruction.
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Affiliation(s)
- Jun Tang
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Medical School, Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Víctor Curull
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Medical School, Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Daniel Ramis-Cabrer
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Medical School, Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain
| | - Xavier Duran
- Scientific, Statistics, and Technical Department, Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain
| | | | - Rafael Aguiló
- Thoracic Surgery Department, Hospital del Mar-IMIM, Parc de Salut Mar, Barcelona, Spain
| | - Esther Barreiro
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital del Mar-IMIM, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Medical School, Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
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